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AJNR Am J Neuroradiol. 2007 Jun-Jul;28(6):1167-71.

Prognostic factors for neurologic outcome after endovascular revascularization of acute symptomatic occlusion of the internal carotid artery.

Author information

1
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. dcsuh@amc.seoul.kr

Abstract

BACKGROUND AND PURPOSE:

Management of acute symptomatic internal carotid artery (ICA) occlusion remains controversial. We evaluated outcome predictors of a good recovery in patients with acute symptomatic ICA occlusion.

MATERIALS AND METHODS:

We retrospectively evaluated 33 consecutive patients (men/women, 23/10; mean age, 66 years) with: 1) acute symptomatic ICA occlusion within 6 hours of symptom onset or with mismatch of symptoms and an early infarct area, 2) National Institutes of Health Stroke Scale (NIHSS) score of 6 or more, and 3) attempted endovascular revascularization of the occluded ICA. Various single and multiple variable analyses were conducted to assess the association of 14 predictors with short-term (1-month NIHSS) and long-term (1-year modified Rankin Scale [mRS]) outcomes.

RESULTS:

Successful recanalization (at or more than grade 2 distal residual occlusion) was obtained in 14 (42%) of 33 and good recovery (mRS <or=2) after 1 year in 11 (33%) of 33. Distal residual occlusion (DRO; P=.005), initial NIHSS score (P=.023), and postprocedural thrombolysis in cerebral infarction (P=.027), retrograde ICA filling (P=.036), and ophthalmic collaterals (P=.046) were significant predictors of short-term outcome. DRO (P=.018) and initial NIHSS (P=.033) were significant predictors of long-term outcome on univariable analysis. DRO was the only significant predictor for short-term (P=.026) and long-term outcome (P=.033) on multivariable logistic regression.

CONCLUSIONS:

Active revascularization of acute symptomatic ICA occlusion resulted in good recovery in one third of patients after 1 year. DRO is an independent predictor of a favorable clinical outcome.

PMID:
17569981
DOI:
10.3174/ajnr.A0492
[Indexed for MEDLINE]
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